Effects of esketamine nasal spray: A Synthesis of Findings from 18 Studies

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Original Abstract of the Article

Major Research Findings

A number of studies have shown that esketamine nasal spray can be an effective treatment option for patients with treatment-resistant depression, particularly when combined with existing antidepressants. 16 , 2 , 17 , 4 Additionally, esketamine nasal spray has been found to work more quickly than traditional antidepressants. 11 One study suggests that esketamine may be more effective in women than men. 4

Benefits and Risks

Benefits Summary

Esketamine nasal spray has shown promise in treating patients with treatment-resistant depression, particularly when combined with existing antidepressants. This treatment may work more quickly than traditional antidepressants.

Risks Summary

Esketamine nasal spray can cause side effects such as nausea, dizziness, hallucinations, and confusion. 8 It can also affect driving ability, so it’s important to use caution when driving. 11 Additionally, there is concern about potential for dependence. 1 It is important to discuss potential risks and side effects with your doctor before starting esketamine treatment.

Comparison Between Studies

Commonalities Between Studies

Many studies have shown that esketamine nasal spray can be effective for patients with treatment-resistant depression, particularly when combined with existing antidepressants. The studies also suggest that esketamine works more quickly than traditional antidepressants.

Differences Between Studies

The effectiveness and side effects of esketamine nasal spray can vary depending on the individual. For example, some studies show that esketamine may be more effective in women than men, while other studies have shown no sex differences. Additionally, some studies suggest esketamine nasal spray may affect driving ability while others do not.

Consistency and Contradictions in Results

While many studies support the potential of esketamine nasal spray for treatment-resistant depression, some studies show limited effectiveness. It is also important to note that esketamine nasal spray has been associated with side effects, emphasizing the need for careful use. Further research is needed to better understand the effectiveness and side effects of this treatment.

Considerations for Practical Application

Esketamine nasal spray may be a viable treatment option for those with treatment-resistant depression. However, it’s important to consult with a doctor before starting any new medication. Your doctor can help you weigh the potential benefits and risks of this treatment and can monitor you for any side effects.

Limitations of Current Research

More research is needed to fully understand the long-term effectiveness and safety of esketamine nasal spray.

Future Research Directions

Future research should focus on further evaluating the long-term effectiveness and safety of esketamine nasal spray. More research is also needed to determine how esketamine works and to identify the optimal way to use this treatment.

Conclusion

Esketamine nasal spray has shown potential for treating patients with treatment-resistant depression. However, it is important to understand the potential side effects and to use this treatment under the guidance of a doctor. If you are struggling with depression, talking to your doctor about potential treatment options, including esketamine nasal spray, is an important step in your journey towards recovery.

Literature analysis of 18 papers
Positive Content
15
Neutral Content
3
Negative Content
0
Article Type
8
0
0
4
18
1.

Abuse liability assessment of eslicarbazepine acetate in healthy male and female recreational sedative users: A Phase I randomized controlled trial.

Author: Levy-CoopermanNaama, SchoedelKerri A, ChakrabortyBijan, BlumDavid, ChengHailong

Treat seizures
Dizziness
Somnolence

This Phase I study evaluated the abuse liability of eslicarbazepine acetate (ESL), a once-daily oral antiepileptic drug, compared with alprazolam (ALP) and placebo (PBO) in recreational CNS depressant users.

Clinical Trial, Phase IThe first stage of clinical trials in humans. Evaluates the safety, tolerability, and pharmacokinetics of a new drug/treatment.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Efficacy and Safety of Fixed-Dose Esketamine Nasal Spray Combined With a New Oral Antidepressant in Treatment-Resistant Depression: Results of a Randomized, Double-Blind, Active-Controlled Study (TRANSFORM-1).

Author: FedgchinMaggie, TrivediMadhukar, DalyElla J, MelkoteRama, LaneRosanne, LimPilar, VitaglianoDawn, BlierPierre, FavaMaurizio, LiebowitzMichael, RavindranArun, GaillardRaphael, AmeeleHans Van Den, PreskornSheldon, ManjiHusseini, HoughDavid, DrevetsWayne C, SinghJaskaran B

Rapid-acting antidepressant
Treatment-resistant depression
Dissociation
Dizziness
Headache
Nausea
Vertigo

Esketamine nasal spray, combined with a newly initiated, open-label, oral antidepressant, showed a treatment effect exceeding what has been considered clinically meaningful for approved antidepressants vs placebo in patients with treatment-resistant depression.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Pharmacotherapies for Treatment-Resistant Depression: How Antipsychotics Fit in the Rapidly Evolving Therapeutic Landscape.

Author: JhaManish K, MathewSanjay J

Depression symptom improvement
Extrapyramidal symptoms
Metabolic dysfunction
Tardive dyskinesia
Weight gain

Treatment-resistant depression (TRD), affecting about one-third of adults with major depressive disorder, is associated with significant morbidity, mortality, and healthcare expenses. While atypical antipsychotics are approved for treating depression, they often provide limited remission and have concerning side effects, especially with long-term use.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Efficacy and safety of esketamine nasal spray by sex in patients with treatment-resistant depression: findings from short-term randomized, controlled trials.

Author: JonesRobyn R, FreemanMarlene P, KornsteinSusan G, CooperKimberly, DalyElla J, CanusoCarla M, NicholsonSusan

Esketamine efficacy
TRD treatment
Dissociation
Dizziness
Nausea
Vertigo

This post hoc analysis of three randomized, controlled studies evaluated the efficacy and safety of esketamine for treatment-resistant depression (TRD) in women and men. The analysis showed no significant sex differences in antidepressant efficacy or safety.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Therapeutic Mechanisms of Ketamine.

Author: MihaljevićSlobodan, PavlovićMatko, ReinerKrešimir, ĆaćićMarko

Depression treatment
Glutamatergic antidepressant
Emergence delirium
Psychotomimetic side effects

Ketamine, previously known for anesthesia, has shown potential as an antidepressant. It is believed to reverse synaptic stress pathology by activating glutamate, leading to improved connectivity for days or weeks. While effective, ketamine can cause side effects like increased salivation and psychotomimetic effects. Esketamine nasal spray, a safer alternative, is now widely approved and provides consistent therapeutic benefit.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

7.

Investigating the Effectiveness and Tolerability of Intranasal Esketamine Among Older Adults With Treatment-Resistant Depression (TRD): A Post-hoc Analysis from the REAL-ESK Study Group.

Author: d'AndreaGiacomo, ChiappiniStefania, McIntyreRoger S, StefanelliGiulia, CarulloRosalba, AndriolaIleana, ZanardiRaffaella, MartiadisVassilis, SensiStefano L, SaniGabriele, ClericiMassimo, Di LorenzoGiorgio, VitaAntonio, PettorrusoMauro, MartinottiGiovanni

Improved depression symptoms

This review discusses the use of esketamine nasal spray (ESK-NS) for treatment-resistant depression (TRD) in older adults. While ESK-NS has demonstrated efficacy and tolerability in clinical trials, real-world data on its effectiveness and safety in this population is limited.

Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

9.

Evaluation of Individual Items of the Patient Health Questionnaire (PHQ-9) and Montgomery-Asberg Depression Rating Scale (MADRS) in Adults with Treatment-Resistant Depression Treated with Esketamine Nasal Spray Combined with a New Oral Antidepressant.

Author: FlodenLysbeth, HudgensStacie, JamiesonCarol, PopovaVanina, DrevetsWayne C, CooperKimberly, SinghJaskaran

Symptom improvement

This study investigated which specific symptoms of depression improved in patients with treatment-resistant depression (TRD) who received esketamine nasal spray in combination with oral antidepressants compared to those who received a placebo. The study found that esketamine was associated with improvements in certain symptoms, but not others.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Esketamine Nasal Spray versus Quetiapine for Treatment-Resistant Depression.

Author: ReifAndreas, BitterIstvan, BuyzeJozefien, CebullaKerstin, FreyRichard, FuDong-Jing, ItoTetsuro, KambarovYerkebulan, LlorcaPierre-Michel, Oliveira-MaiaAlbino J, MesserThomas, Mulhern-HaugheySiobhán, RiveBenoît, von HoltChristian, YoungAllan H, GodinovYordan,

None mentioned
None mentioned

This study looked at the effectiveness and safety of esketamine nasal spray and extended-release quetiapine for treatment-resistant depression.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

11.

The effects of intranasal esketamine on on-road driving performance in patients with major depressive disorder or persistent depressive disorder.

Author: DijkstraFrancis M, van de LooAurora Jae, AbdulahadSmedra, BosmaElse R, HartogMitch, HulsHendrikje, KuijperDianne C, de VriesEsther, SolankiBhavna, SinghJaskaran, AluisioLeah, ZannikosPeter, StuurmanFrederik E, JacobsGabriël E, VersterJoris C

No driving impairment
Dissociation
Dizziness
Sedation

Intranasal esketamine did not impair driving performance the next morning following a single dose, or on the same day after repeated administration.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Early Clinical Experiences of Esketamine Nasal Spray in the UK in Adults with Treatment-Resistant Major Depressive Disorder: Advisory Panel Recommendations.

Author: YoungAllan H, AbdelghaniMohamed, JuruenaMario F, NikolovaViktoriya L, NilforooshanRamin

TRD treatment

This article discusses the use of esketamine nasal spray for treating treatment-resistant depression (TRD), a challenging condition with limited treatment options.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

14.

Effect of Esketamine Nasal Spray on Olfactory Function and Nasal Tolerability in Patients with Treatment-Resistant Depression: Results from Four Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase III Studies.

Author: DotyRichard L, PopovaVanina, WylieCrystal, FedgchinMaggie, DalyElla, JanikAdam, Ochs-RossRachel, LaneRosanne, LimPilar, CooperKim, MelkoteRama, JamiesonCarol, SinghJaskaran, DrevetsWayne C

Esketamine for TRD

Esketamine nasal spray, used in combination with oral antidepressants, did not adversely affect olfactory function or nasal health in patients with treatment-resistant depression. In four clinical studies, 1142 patients received either esketamine or placebo nasal spray for short-term (4 weeks) or long-term (16-100 weeks) treatment. No significant differences were found in olfactory function or nasal health measures between the groups.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

15.

Real-world experience of esketamine use to manage treatment-resistant depression: A multicentric study on safety and effectiveness (REAL-ESK study).

Author: MartinottiGiovanni, VitaAntonio, FagioliniAndrea, MainaGiuseppe, BertolinoAlessandro, Dell'OssoBernardo, SiracusanoAlberto, ClericiMassimo, BellomoAntonello, SaniGabriele, d'AndreaGiacomo, ChiaieRoberto Delle, ConcaAndreas, BarlatiStefano, Di LorenzoGiorgio, De FazioPasquale, De FilippisSergio, NicolòGiuseppe, RossoGianluca, ValcheraAlessandro, NuciforaDomenica, Di MauroStefania, BassettiRoberta, MartiadisVassilis, OlivolaMiriam, BellettiSandro, AndriolaIleana, Di NicolaMarco, PettorrusoMauro, McIntyreRoger S, di GiannantonioMassimo,

Esketamine effective for TRD
Safe and tolerable

This real-world study of 116 patients with treatment-resistant depression (TRD) treated with esketamine nasal spray found a significant reduction in depressive symptoms and a dramatic increase in clinical response and remission rates. No unexpected safety concerns were observed.

Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study.

Author: PopovaVanina, DalyElla J, TrivediMadhukar, CooperKimberly, LaneRosanne, LimPilar, MazzuccoChristine, HoughDavid, ThaseMichael E, SheltonRichard C, MoleroPatricio, VietaEduard, BajboujMalek, ManjiHusseini, DrevetsWayne C, SinghJaskaran B

Depression treatment

This study compared the efficacy and safety of switching patients with treatment-resistant depression from an ineffective antidepressant to flexibly dosed esketamine nasal spray plus a newly initiated antidepressant or to a newly initiated antidepressant plus placebo nasal spray.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

18.

Molecular mechanisms underlying the antidepressant actions of arketamine: beyond the NMDA receptor.

Author: WeiYan, ChangLijia, HashimotoKenji

Depression treatment

Arketamine, a potent enantiomer of (R,S)-ketamine, has shown greater potency and longer-lasting antidepressant-like effects than esketamine in rodent studies, despite having lower binding affinity for the NMDAR. While (R,S)-ketamine and its enantiomers show promise in treating depression and cognitive impairment, the precise molecular mechanisms underlying their antidepressant effects remain unclear. Further research is needed to explore the potential of arketamine in treating various neurological and psychiatric disorders.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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